The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale.

Guidelines for the Primary Prevention of Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

Venous thromboembolism (VTE) is responsible for the hospitalization of >250 000 Americans annually and represents a significant risk for morbidity and mortality. Despite the publication of evidence-based clinical practice guidelines to aid in the management of VTE in its acute and chronic forms, the clinician is frequently confronted with manifestations of VTE for which data are sparse and optimal management is unclear. In particular, the optimal use of advanced therapies for acute VTE, including thrombolysis and catheter-based therapies, remains uncertain. This report addresses the management of massive and submassive pulmonary embolism (PE), iliofemoral deep vein thrombosis (IFDVT),and chronic thromboembolic pulmonary hypertension (CTEPH). The goal is to provide practical advice to enable the busy clinician to optimize the management of patients with these severe manifestations of VTE. Although this document makes recommendations for management, optimal medical decisions must incorporate other factors, including patient wishes, quality of life, and life expectancy based on age and comorbidities. The appropriateness of these recommendations for a specific patient may vary depending on these factors and will be best judged by the bedside clinician.

Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension A Scientific Statement From the American Heart Association

AAA
: abdominal aortic aneurysm
ACEI
: angiotensin converting enzyme inhibitor
ACS
: acute coronary syndromes
AF
: atrial fibrillation
AKI
: acute kidney injury
AKIN
: Acute Kidney Injury Network
ARB
: angiotensin receptor blocker
ASA
: American Society of Anesthesiologists
b.i.d.
: bis in diem (twice daily)
BBSA
: Beta-Blocker in Spinal Anesthesia
BMS
: bare-metal stent
BNP
: B-type natriuretic peptide
bpm
: beats per minute
CABG
: coronary artery bypass graft
CAD
: coronary artery disease
CARP
: Coronary Artery Revascularization Prophylaxis
CAS
: carotid artery stenting
CASS
: Coronary Artery Surgery Study
CEA
: carotid endarterectomy
CHA2DS2-VASc
: cardiac failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65–74 and sex category (female)
CI
: confidence interval
CI-AKI
: contrast-induced acute kidney injury
CKD
: chronic kidney disease
CKD-EPI
: Chronic Kidney Disease Epidemiology Collaboration
Cmax
: maximum concentration
CMR
: cardiovascular magnetic resonance
COPD
: chronic obstructive pulmonary disease
CPG
: Committee for Practice Guidelines
CPX/CPET
: cardiopulmonary exercise test
CRP
: C-reactive protein
CRT
: cardiac resynchronization therapy
CRT-D
: cardiac resynchronization therapy defibrillator
CT
: computed tomography
cTnI
: cardiac troponin I
cTnT
: cardiac troponin T
CVD
: cardiovascular disease
CYP3a4
: cytochrome P3a4 enzyme
DAPT
: dual anti-platelet therapy
DECREASE
: Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography
DES
: drug-eluting stent
DIPOM
: DIabetic Post-Operative Mortality and Morbidity
DSE
: dobutamine stress echocardiography
ECG
: electrocardiography/electrocardiographically/electrocardiogram
eGFR
: estimated glomerular filtration rate
ESA
: European Society of Anaesthesiology
ESC
: European Society of Cardiology
EVAR
: endovascular abdominal aortic aneurysm repair
FEV1
: Forced expiratory volume in 1 second
HbA1c
: glycosylated haemoglobin
HF-PEF
: heart failure with preserved left ventricular ejection fraction
HF-REF
: heart failure with reduced left ventricular ejection fraction
ICD
: implantable cardioverter defibrillator
ICU
: intensive care unit
IHD
: ischaemic heart disease
INR
: international normalized ratio
IOCM
: iso-osmolar contrast medium
KDIGO
: Kidney Disease: Improving Global Outcomes
LMWH
: low molecular weight heparin
LOCM
: low-osmolar contrast medium
LV
: left ventricular
LVEF
: left ventricular ejection fraction
MaVS
: Metoprolol after Vascular Surgery
MDRD
: Modification of Diet in Renal Disease
MET
: metabolic equivalent
MRI
: magnetic resonance imaging
NHS
: National Health Service
NOAC
: non-vitamin K oral anticoagulant
NSQIP
: National Surgical Quality Improvement Program
NSTE-ACS
: non-ST-elevation acute coronary syndromes
NT-proBNP
: N-terminal pro-BNP
O2
: oxygen
OHS
: obesity hypoventilation syndrome
OR
: odds ratio
P gp
: platelet glycoprotein
PAC
: pulmonary artery catheter
PAD
: peripheral artery disease
PAH
: pulmonary artery hypertension
PCC
: prothrombin complex concentrate
PCI
: percutaneous coronary intervention
POBBLE
: Peri-Operative Beta-BLockadE
POISE
: Peri-Operative ISchemic Evaluation
POISE-2
: Peri-Operative ISchemic Evaluation 2
q.d.
: quaque die (once daily)
RIFLE
: Risk, Injury, Failure, Loss, End-stage renal disease
SPECT
: single photon emission computed tomography
SVT
: supraventricular tachycardia
SYNTAX
: Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery
TAVI
: transcatheter aortic valve implantation
TdP
: torsades de pointes
TIA
: transient ischaemic attack
TOE
: transoesophageal echocardiography
TOD
: transoesophageal doppler
TTE
: transthoracic echocardiography
UFH
: unfractionated heparin
VATS
: video-assisted thoracic surgery
VHD
: valvular heart disease
VISION
: Vascular Events In Noncardiac Surgery Patients Cohort Evaluation
VKA
: vitamin K antagonist
VPB
: ventricular premature beat
VT
: ventricular tachycardia

Guidelines summarize and evaluate all available evidence, at the time of the writing process, on a particular issue with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic …

/pdf/2014-esc-esa-guidelines-on-non-cardiac-surgery-bbdr0c4n87.pdf

2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA).

Echocardiographic imaging is ideally suited for the evaluation of cardiac mechanics because of its intrinsically dynamic nature. Because for decades, echocardiography has been the only imaging modality that allows dynamic imaging of the heart, it is only natural that new, increasingly automated techniques for sophisticated analysis of cardiac mechanics have been driven by researchers and manufacturers of ultrasound imaging equipment.Several such technique shave emerged over the past decades to address the issue of reader's experience and inter measurement variability in interpretation.Some were widely embraced by echocardiographers around the world and became part of the clinical routine,whereas others remained limited to research and exploration of new clinical applications.Two such techniques have dominated the research arena of echocardiography: (1) Doppler based tissue velocity measurements,frequently referred to as tissue Doppler or myocardial Doppler, and (2) speckle tracking on the basis of displacement measurements.Both types of measurements lend themselves to the derivation of multiple parameters of myocardial function. The goal of this document is to focus on the currently available techniques that allow quantitative assessment of myocardial function via image-based analysis of local myocardial dynamics, including Doppler tissue imaging and speckle-tracking echocardiography, as well as integrated backscatter analysis. This document describes the current and potential clinical applications of these techniques and their strengths and weaknesses,briefly surveys a selection of the relevant published literature while highlighting normal and abnormal findings in the context of different cardiovascular pathologies, and summarizes the unresolved issues, future research priorities, and recommended indications for clinical use.

https://www.asefoundation.org/wp-content/uploads/2013/05/Current-and-Evolving-Echo-Tech-for-the-Quantitative-Eval-of-Cardiac-Mechanics-Part-1.pdf

Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications: Endorsed by the Japanese Society of Echocardiography

This third edition of what has now become a well-established textbook in cardiovascular medicine is again edited by Dr Eugene Braunwald with the assistance of 65 other authors who read like a Who's Who of American Cardiology. Since the second edition, 12 new chapters have been added or substituted and others have been significantly revised. The first volume includes Part I on "Examination of the Patient" and Part II on "Normal and Abnormal Circulatory Function." The second volume deals with specific diseases. Part III, "Diseases of the Heart, Pericardium and Vascular System," includes new sections on "Risk Factors for Coronary Artery Disease," "The Pathogenesis of Atherosclerosis," and "Interventional Catheterization Techniques." Part IV, "Broader Perspectives on Heart Disease and Cardiologic Practice," includes new chapters on "Genetics and Cardiovascular Disease," "Aging in Cardiac Disease," and "Cost Effective Strategies in Cardiology." The last 200 pages of the book (Part V) are devoted to

Heart Disease: A Textbook of Cardiovascular Medicine

cardiograms were reexamined and LA volume measured using the AL, SIMP, and PE methods. Of 102 consecutive patients evaluated, 97 had a measure of LA volume using all 3 methods. A significant difference in the measurement of mean+ SD LA volume was noted among the 3 different methods: 37+ 16 mL/m 2 for AL, 34+ 14 mL/m 2 for SIMP, and 27+ 12 mL/m 2 for PE. The PE method yielded routinely smaller values compared with either the AL or SIMP method (P , 0.001). Differences increased with increased LA volume. The SIMP method derived consistently smaller (,5 mL/m 2 ) values than those of the AL method, consistent across the full range of LA volumes. Conclusion Significant differences exist among these 3 commonly used methods for measuring LA volume. Standardization of the measurement of LA volume is recommended.

Three methods for evaluation of left atrial volume

Background: The association between visceral obesity and cardiovascular risk has been well described. Some studies show a proportional relationship between the presence of visceral obesity and epicardial fat. Measuring the amount of epicardial adipose tissue (EAT) can be a novel parameter that is inexpensive and easy to obtain and may be helpful in cardiovascular risk stratification. However, the relationship between epicardial fat and cardiac function and that between epicardial fat and cardiac risk factors is less well described. Objectives: To evaluate the association between echocardiographic epicardial fat and the morphologic and physiologic changes observed at echocardiography and to evaluate the association between epicardial fat and cardiac risk factors. A cross-sectional study of 97 echocardiographic studies (females, n = 42) was conducted. Two groups were identified: epicardial fat ≥ 5 mm (group I) and Results: Epicardial fat >5 mm was associated with LA enlargement, with lower ejection fraction, increased left ventricular mass, and abnormal diastolic function. On a multivariable regression analysis, all these parameters also correlated individually with EAT thickness independent of age. Hyperglycemia (DM), systolic hypertension, and lipid parameters for metabolic syndrome showed a trend for positive association, but this was not statistically significant. The association was not significant even for higher cutoff limits of EAT thickness. Conclusion: Epicardial fat >5 mm is associated with cardiac abnormalities on echocardiography. This is a sensitive assessment of body fat distribution, is easily available at echocardiography, and is simple to acquire at no added cost. Further studies looking at the appropriate cut-off thickness of EAT and the sites of measurement to be used are needed. Comparison of this simple and inexpensive measure with other measures of obesity, such as waist-hip ratio, body mass index, Dexa scan of visceral fat, and magnetic resonance imaging of visceral, are needed.

Epicardial fat and its association with cardiovascular risk: a cross-sectional observational study.

In part 1 of this overview, the authors reviewed the epidemiology, definitions, pathophysiology, and interaction of inflammatory markers that are elaborated from the very active paracrine adipocyte. In part 2, they focus on the management of the metabolic syndrome. Management of this syndrome includes identification of individuals in the early stages of the syndrome and emphasizes the risk of developing diabetes mellitus and the progression to cardiovascular disease. This can be accomplished by simple physical examination and an assessment of routine laboratory findings, which should include measurement of fasting glucose, a lipid profile, and body morphometrics. A 10-year risk assessment is needed in patients who have a diagnosis of the metabolic syndrome. The most important therapeutic intervention in the metabolic syndrome is lifestyle change, with a focus on weight reduction and regular leisure time physical activity.

The metabolic syndrome and cardiovascular disease: part 2.

Background: In patients with primary hyperoxaluria (PH), oxalate overproduction can result in recurrent urolithiasis and nephrocalcinosis, which in some cases results in a progressive decline in renal function, oxalate retention, and systemic oxalosis involving bone, retina, arterial media, peripheral nerves, skin, and heart. Oxalosis involving the myocardium or conduction system can potentially lead to heart failure and fatal arrhythmias. Methods and Results: A retrospective review of our institution's database was conducted for all patients with a confirmed diagnosis of PH between 1/1948 and 1/2006 (n=103). Electrocardiogram (ECG) and echocardiography were used to identify cardiac abnormalities. Ninety-three patients fulfilled the inclusion criteria, 58% were male. Mean follow-up was 11.9 (median 8.8) years. In 38 patients who received an ECG or echocardiography, 31 were found to have any cardiac abnormalities. Cardiac findings correlated with decline in renal function. Conclusions: Our data suggests that physicians caring for patients with PH should pay close attention to cardiac status, especially if renal function is impaired. (Circ J 2010; 74: 2403-2409)

Cardiac Abnormalities in Primary Hyperoxaluria

Echocardiography can be used for rapid and accurate risk stratification of patients with pulmonary embolism to appropriately direct the therapeutic strategies for those at high risk. Echocardiography is an ideal risk stratification tool in this regard because of its easy portability to the emergency room or to the bed side. It can be performed at a relatively low cost and at no risk to the patient. Furthermore, echocardiography allows repetitive noninvasive assessment of the cardiovascular and hemodynamic status of the patient and the response to the therapeutic interventions. Right ventricular hypokinesis, persistent pulmonary hypertension, a patent foramen ovale, and a free floating right heart thrombus are echocardiographic markers that identify patients at a higher risk for morbidity and mortality. Such patients warrant special consideration for thrombolysis or embolectomy.

Panupong Jiamsripong

Papers

Three methods for evaluation of left atrial volume

Epicardial fat and its association with cardiovascular risk: a cross-sectional observational study.

The metabolic syndrome and cardiovascular disease: part 2.

Cardiac Abnormalities in Primary Hyperoxaluria

Critical appraisal on the utility of echocardiography in the management of acute pulmonary embolism.